There’s an ongoing war taking place in the world today, and it’s not between countries, states, nationalities, or rival ethnic groups. It’s not even between individuals, but instead it’s taking place on the landscape of the human mind, a war causing great distress, attacking individuals’ thoughts and emotions.

The war is called depression, affecting individuals of all races, socioeconomic classes, genders, all educational levels, and ages. In other words, it shows no prejudice against whom it places in serious peril.

Clinicians categorize depression as a mood disorder, a category that includes major depressive disorder, dysthymic disorder, and bipolar disorder. Taken together, the National Institute of Mental Health states that 20.9 million Americans suffer with various depression related mood disorders in any given year.

But depression doesn’t stop at American borders. According to the World Health Organization, depression affects 121 million people worldwide, and is the leading cause of disability in developed countries. The organization projects it to become the second leading cause of disability across the world by the year 2020.

In the U.S. alone, the annual cost of disability resulting from depression costs $70 to $80 billion. Some call depression an epidemic, but if it weren’t a mental health disorder, most would call it terrorism.

To root out its causes, identify its patterns and develop effective treatments and interventions, researchers have made significant progress in identifying all the factors that contribute to this disease, especially over the past 20 years. However, it remains a complex – and often controversial – topic and area of research.

Scientists breakdown the roots of depression into the following categories, considering these to be the major factors leading to depression:

Generational and cultural factors

Biology

Stressful life events

Generational and Cultural Factors

In her book “Generation Me: Why Today’s Young Americans Are More Confident, Assertive, Entitled – And More Miserable Than Ever Before,” Jean Twenge, PhD, attributes this large increase to a culture centered on the “self.” Especially over the last few decades, she states, a disproportionate concern for self-esteem has created what she calls the “Me Generation.”

Twenge, professor of psychology at San Diego State University, groups individuals born from the 1970s through the 1990s as members of this self-important group of individuals.

The book references her research that analyzed data gathered by various organizations over several decades on 1.3 million young Americans starting in the 1950s. This ongoing data collection uses the same questionnaires given annually to young people and college students, allowing Twenge to compare data from questionnaires of current generations to their parents – or the infamous Baby Boomers.

Generations born between the years of 1970 through the 1990s include a wide range of individuals, including two specific cultural groupings: Generation X (Gen X), or those typically born between 1961 and the mid-1970s; and Generation Y (Gen Y), or those born between the mid-1970s and 2000. But for Twenge, both Gen Xers and Gen Yers are children of the Boomers, children raised on a high dose of the “sky is the limit,” “you can have anything you want,” and “the self comes first.” Ironically, these individuals raised on high doses of self-esteem building are the most depressed out of all previous generations on record, according to Twenge.

In one of her most recent meta-studies that also analyzes data taken over a number of years, Twenge and five colleagues used data from the Minnesota Multiphasic Personality Inventory (MMPI), a personality test given to U.S. college students going back to 1938, and high school students going back to 1951.

Published in 2010 in the journal Clinical Psychology Review, the results from the MMPI study were again consistent with other her other studies, and those of other generational researchers. These results identify steadily increasing rates of mental disorders over the last three decades, including depression and anxiety, estimating that 85% of today’s college students scored above the 1930’s to 1940’s average.

In the journal article “Birth Cohort Increases in Psychopathology Among Young Americans, 1938-2007: A Cross-Temporal Meta-Analysis of the MMPI,” she and her colleagues said that a plausible explanation for this increase stems from the culture in which Gen Xers and Gen Yers were raised. Those born in the U.S, and raised during the 1980s, for example, know a completely different culture than those raised during the 1950s. Logically this makes sense, the researchers state, since this principle also holds true when studying traits and behaviors across world regions – culture directly influences variations in how people think and behave.

The study states that the U.S. culture of the past three decades “has increasingly shifted toward an environment in which more young people experience poor mental health and psychopathology, possibly due to an increased focus on money, appearance, and status, rather than on community and close relationships.” As more proof for their theory, the researchers cite a survey taken of high school and college students on their values and goals. More high school students over these last three decades stated that “having a lot of money” is important to them than students from the 1960s. And more college students stated that it’s important to “be well-off financially.”

As these culturally “extrinsic” goals have increased, “intrinsic” goals have decreased. Intrinsic goals pertain to finding meaning and purpose in life, and pursuing and developing one’s inherent interests or passions. Intrinsic goals also focus on community activism and participation. One cautionary statement in this particular study states that because the study only looked at high school students and college students, the results cannot be generalized to the American population as a whole.

And other researchers point to other considerations. Hasn’t every generation looked back on younger generations, finding them more selfish and interested in materialism than previous generations? And weren’t the Baby Boomers labeled the most “self-absorbed” generation of all generations?

Another study, “Monitoring the Future,” funded by the National Institutes of Health, reveals contrasting results to that of Twenge and her colleagues.

Monitoring the Future is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Annually, it surveys approximately 50,000 8th, 10th and 12th grade students. In addition, a sample from each graduating class answers annual follow-up questionnaires for a number of years after their initial participation. So far, the results show slight support for generational differences, mainly centered on Gen Y individuals worrying less about social issues, having less trust of others, and being more cynical of organizations and public institutions.

However, the study also found that Gen Y individuals were less worried about keeping up with materialistic trends, and were disdainful of explicit consumerism.

Other researchers and psychologists single out these studies and their contradicting opinions as proof that depression isn’t easily generalized, and that researchers and mental health practitioners must look at all facets of an individual’s history.

Biological, Cognitive and Neuroscience

Research taking place today, for example, in the biological, cognitive, and neurosciences filter out culture, and focus more acutely on brain chemistry and dysfunction.

Scientists have long acknowledged the brain’s circuitry and biochemical processes as integral aspects of depression, specifically as these processes control neurotransmitters that control mood. Beginning in the 1970s, neuroimaging technologies rapidly advanced the study of how brains function – or fail to function. Functional magnetic resonance imaging (fMRI), which became available to researchers over the past 20 years, gives cognitive neuroscientists a 3-D view of neural activity within the brain.

Studies using this technology demonstrate the role of serotonin, norepinephrine, and dopamine as they regulate mood in the human body. Scientists still aren’t exactly sure why individuals with depression have low amounts of these neurotransmitters, yet they do know that for some, antidepressants that specifically target how the brain balances these these neurotransmitters are an effective therapeutic intervention. (See the article Medications for Depression.)

Yet much controversy surrounds the issue of prescribing antidepressants, with some claiming that too often an individual is prescribed a pill without receiving the benefits of psychotherapy. Leigh Matthews, psychologist and director of Urban Psychology in Brisbane, Australia, treats adult clients for depression. Matthews told allpsychologycareers.com in an e-mail interview that there are an abundance of studies evidencing the efficacy of the combination of medication and psychotherapy.

But psychology, Matthews said, tries to first focus on treatment without medication, so it’s not always respected by other disciplines, such as general practice physicians or psychiatrists. But the process of psychotherapy and its outcomes last far longer than simply prescribing medication. Yet there are times when medication is absolutely essential, according to Matthews, who also supervises psychologists-in-training at the University of QLD, and those completing their internships through the Australian College of Applied Psychology.

She said when clients are so depressed that they can’t get out of bed, think rationally, or use any of the strategies proposed in session, then it’s time for medication. Or when clients verbalize suicidal ideation and intent indicating severe depression, then medication is absolutely required.

Also if an individual has a long history of depression, or a strong family history suggesting a genetic basis, then “perhaps they, like a diabetic requiring insulin, need long-term pharmacotherapy to rectify neurochemical imbalances.”

Stressful Life Events

Past trauma and stress are also highly correlated with depression. Women, who suffer with depression at twice the rate of men often have significant trauma in their histories that lead to depression.

In the American Journal of Psychiatry article “The Prediction of Major Depression in Women: Toward an Integrated Etiologic Model,” the authors showed that stress and trauma lead to more depression in women than even genetics. Sexual and physical abuse is highly correlated with depression, either in a woman’s current life or from childhood. Loss of a parent during childhood, or the loss of a significant other or spouse are also highly correlated with depression. This finding also parallels the work of other researchers. Women typically experience more stress in today’s society, often juggling the major share of parenting, housework, and taking care of aging parents – all while maintaining full-time jobs.

According to Psychologist Matthews, who treats a large number of women, and has worked at The Sydney Clinic Private Psychiatric Hospital Mood Disorders Unit, women become consumed with helping others. They sacrifice themselves, neglecting self-care and other things necessary for their own survival. And they usually lack assertiveness training skills.

A Multi-Factorial Disease

Brain biology, genetics, trauma, culture, and generational differences are all culprits in this disease, clearly identifying it as condition of many factors. Despite any controversy or mixed opinions on which factors play a stronger role in the disorder, the good news is that 80% of those who do seek treatment for clinical depression show an improvement in symptoms, according to Mental Health America (MHA). And 70% have a full remission of the disorder.

If you have a passion for helping and treating those with depression, consider a career in the mental health field.

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